Failure to disclose dental mistakes
Abstract
This research paper aims at scrutinizing the common practice of nondisclosure of mistakes, particularly in dental practice. While the term nondisclosure sounds ordinary and casual to some extent, it carries with it a great deal of magnitude. The paper analyzes the contemporary situations that have forced dentists, in the past, to hide errors from their patients after they have occurred. Moreover, it proceeds to evaluate the merits of disclosing the mistake to the patient and the best procedure to use in unveiling the errors. The paper examines the past research studies regarding nondisclosure of errors to patients that argue for and against the mistakes. Finally, the article gives recommendations on how best to handle adverse effects during dental practice instead of covering them.
It is unethical for a dentist to hide dental mistakes.
Introduction
Dentists face an ethical dilemma while executing their day to day professional duties. One of them includes whether or not to disclose errors that may have occurred when operating or treating a patient. Treatment errors will possibly continue happening as dentists remain mortal beings that align with the adage, to err is human. The dentist is obligated to disclose issues that may emerge as they treat their patients. Additionally, the patient has the right to know about any matter related to the consequence of their treatment, however small, so that they can receive appropriate management (Nainar, 2018). The moral obligation is to report to the patient any catastrophic event that arises as they treat their patients, which calls for explicit communication. They are expected to acknowledge the game, discuss the facts related to it with the patient, apologize and show regret to the issue, take immediate action to reduce the adverse effects on the patient, and take risk management procedures to avoid similar harmful results.
Any dentist who fails to disclose an unfortunate event that occurs as they execute their professional duty is considered a breach of fiduciary duty and is subject to punishment from the law authorities. A fiduciary is defined as “one who owes to another the duties of good faith, trust, confidence, and candor.” Additionally, dentists should not attempt to fix the problem without the consent of the patient. If the patient is not aware of a problem that may have occurred in the course of their treatment, they won’t beware of the facts related to the event (Murariu, 2016). Moreover, they won’t be aware of the repercussions of not managing the issue, nor do they know the nature of the course of action. This fiduciary relationship between a dentist and a patient is dependent on the principle of autonomy, nonmaleficence, beneficence, justice, and fidelity at all times.
Background
The most common definition of a medical error is “An act of omission or commission in planning or execution that contributes or could contribute to an unintended result,” Holden, Of late, with the execution of professional code of ethics in various health systems, the unveiling of medical mistakes increases the standards of the healthcare system and avoids future mistakes.
A study conducted in Canada, Australia, the UK, and the US revealed that patients suffer harm on account of medical care. According to the study, about 10 % of inpatients suffer harm, one in two hundred die in part due to such incidents as medical errors. In comparison, about 40% of all such cases are unavoidable. In the past, the medics fraternity has been reluctant to disclose errors. In the new era, a dentist and any medical professional have a duty to exhibit career competence, be honest with patients, raise the quality of care, and maintain integrity in medical practice.
Medical issues related to dentistry result from some factors that may be unintentional. Inappropriate medication prescription is one of the medical errors that dentists do while treating their patients. It is the moral duty of a dentist to ensure a high level of accuracy while executing their professional obligations, adverse effects on their patients. The other errors that increase patients’ risks in dentistry include; lack of updated scientific evidence relating to the treatment, poor maintenance of equipment, and failure to preserve updated patient records. Moreover, failure to reach a consensus with a patient before treating them is a factor that increases the risk of a medical error to occur. Inaccuracy in establishing proper infection measures, diagnosing a dental issue, averting accidents and complications, and failure to do follow-up care and adhering to state laws or regulations that depict quality standards for dental care.
Hypothesis
There are two fundamental responsibilities related to the provision of dental treatment. Firstly, the delivery of such care needs to be of quality standards and secondly, respect for the patient’s independence or autonomy, and their right to influence what happens to their body. Before treating a patient, the consensus is essential to bring the patient aboard in treating them. It is also crucial to discuss with the patients about the procedure of treatment, possible adverse outcomes, and provide recommendations that align with a patient’s best interests (Renton, 2016). Nevertheless, the patient’s awareness only prepares them to handle the projected outcomes of treatment but does not reduce the risk in question. The issue of nondisclosure to patients is defined using the following principles;
Principle of respect for autonomy
The autonomy which defends the self-determination of patients aligns with truth-telling. Failure to disclose medical errors to patients in dentistry overlooks offends and degrades their rights of autonomy. Moreover, lying to patients disrupts the principle of consensus. The patients may not comprehend the need for more interventions or an extended stay in the hospital that becomes inevitable as a result of a disguised error during treatment.
According to Beauchamp and Childress, the principle of respect for autonomy is beyond mere interference with other people’s affairs. In various situations, it entails obligations to preserve other people’s capacities to make autonomous choices while assisting in connecting fears and other events that destroy or interfere with their autonomous acts (Gross, 2019). Respect in this context entails accepting the rights of decision making and enabling people to act autonomously. In contrast, disrespect for autonomy stands for perceptions and acts that overlook, abuse or demean other people’s rights of autonomy.
Nonmaleficence
The principle of nonmaleficence proclaims a compulsion not to impose harm on others. Although a mistake may harm a patient, failure to disclose it to them worsens the situation. It causes needless pain on the patient as they think that their prolonged stay in the hospital results from the underlying course. The implication is that the understanding that their prolonged stay in the hospital results from an error that occurred during treatment relieves them of the distress, thus preventing it from worsening the patient’s condition ((Gross, 2019). Instead of adding abuse to the error, the doctor can remove the insult from it by acting accordingly to prevent adverse harm to the patient. Such actions involve disclosing the mistake to the patient and letting them know about the crucial procedures taken to minimize the adverse effects and avoid the prolonged happening of such mistakes.
Beneficence
The principle of beneficence stands for an ethical compulsion to act in a way that benefits others. However, not all acts of beneficence are compulsory. Still, this norm creates a compulsion for health care professionals to assist patients in advancing their crucial and genuine interests, which entail the avoidance and exclusion of adverse events. Failure to reveal a medical error that has happened to a patient and letting them assume that whatever they are experiencing is a result of their underlying condition is mean and breaches the norm of beneficence. The patient’s knowledge and comprehension that an error has occurred may dismiss worries about slow recovery or difficulties and will surely bring benefits.
Justice
The principle of justice refers to just, equitable, and proper treatment in taking into account what is owed to individuals. In this context, the implication is that patients should get what they merit. This principle commands the unveiling of a mistake to guarantee reparation to patients. If the hospital bill of a patient increases as a result of the dentist’s mistake, they have a right to claim a reimbursement. Most importantly, the principle of justice asserts that if the victim is to get fairness, disclosing the mistake and apologizing for, it is inevitable. Understanding the mistake that happened helps the patient claim the indispensable reimbursement or compensation.
Fidelity
The compulsion of fidelity in dentistry and the field of medicine at large refers to principles that stipulate the ethical norms of autonomy and justice, among others—applying the results to the compulsion of reliability and fidelity. The dentist should be honest with their patients, sometimes they are misguided by a mistaken longing to avoid causing worries to patients, which causes them not to be honest with patients. The fallacy that nondisclosure protects patients is misguided since patients always want to know the slightest mistakes that may have happened to them during treatment. The core of the dentist-patient interaction is truthful communication, lying to patients not only demeans the accuracy of the particular dentist but also sends serious hesitation on the dentistry profession’s integrity as a whole.
In conclusion, justice, fidelity, beneficence, nonmaleficence, and respect for autonomy all reveal that disclosure of errors in dentistry is warranted on ethical grounds and sustains these values.
Opposing views against disclosure
Although several reasons such as legal accountability, patient distress, and loss of status and freedoms as well as license cancellation among others are the reasons why dentists fail to disclosure errors to patients, they are not enough reasons why doctors do not disclose errors to patients. Notably, a deception, which is an offense against the ethical rule, is the core of nondisclosure. Additionally, a violation is justifiable if it is reasonable to give it a priority even if everyone is aware that such a violation is allowed. Since lying to patients in the form of nondisclosure of medical mistakes does not justify it, it is an unwarranted offense against a crucial ethical rule.
Legal liability
Dentists and other medical practitioners get sued after making mistakes during their duty executions, but evidence reveals that patients seek more than compensation or reimbursements after errors have occurred during their treatment. Observations revealed that most patient discontent resulted from the doctor’s rudeness rather than the mistake itself. Notably, studies show that about half of unethical cases in dentistry and medical practice could be avoided through the unveiling of mistakes to patients and apologizing to them. Evidence proves that what patients need most after an error has occurred during treatment is an explicit explanation of the course, and if reasonable, an apology. Disappointedly, most of them are rejected, and it becomes inevitable for them to seek legal help.
Instituting a full disclosure in dental practice is ethical and raises patients’ confidence about the dentist and reduces liability payments. Additionally, explicit communication with patients and their representatives, apologizing for mistakes, and learning from them, explicit discussions with petitioners, and deliberate reimbursement of the victims would reduce solicitor expenses and malpractice filings. However, findings reveal that disclosure of mistakes may not reduce malpractice, failure to unveil mistakes lifts the desire for patients to sue their dentists and medics. Since victims are more likely to sue of medics, they do not reveal their mistakes than if otherwise, attempting to reduce lawsuit through nondisclosure is unethical and illegal.
Patient distress
Some dentists and medics fail to disclose their errors to patients on the premises that this would cause a patient’s distress. “Doctors might be permitted not to tell if they have good reason to believe that disclosure would undermine the patient’s autonomy in some way (e.g., damage the already severely depressed patient). Or the patient might have told the doctor explicitly, ‘Doctor, if anything goes wrong, I don’t want to know about it'” (Zaghloul, 2018). The argument is that patients seem to suffer distress to the extent of turning unreasonable or extended psychological suffering, rather than if they had not known about the mistakes.
However, the assertion that disclosure of errors to patients is unsound. The notion that patients might get distressed if they learn that a mistake occurred during their treatment is not justifiable. It is common for patients to get upset when avoidable errors happen during their treatment, but their reasoning capacity is not impaired. Upsetting a patient cannot be equated to patient damage (Zaghloul, 2018). The assertion that disclosure of errors to patients is, therefore, unscientific and exaggerated. Notably, sensitive passing of information to patients avert the psychological damage that has been previously used as an excuse by medics to hide the truth from patients. While patients express their sadness after an error has occurred during their care, worries about other possible errors in the future, recession against extended recovery, and irritation at the mistake being avoidable, most of them react differently depending on how the information was disclosed. Patients indicate less distress if the disclosure of an error is explicit and straightforward.
Loss of reputation, privileges and license revocation
Losing reputation, privileges, cancellation of licenses, shame, and humiliation are some of the fears that prevent doctors from unveiling mistakes to patients. The dilemma that dentists and medics face is whether the merits of revealing the errors to the patients are worth the risk they mat face ((Renton, 2016). However, it is prudent to weigh between disguising the errors made until the situations worsen or revealing them early enough and handling them appropriately. In essence, a dentist’s reputation would be ruined more if he/she hides the patient’s error until the victim finds out on their own than if the physician reveals it voluntarily and early enough. With the appropriate strategies in place relating to what medics should do when a mistake occurs, equipping them with skills on handling such situations ethically and disclosing it to patients appropriately, the medics would be a lot more willing to unveil mistakes when they happen.
In conclusion, errors in medical practice, dentistry included, will remain to be ill-fated but unpreventable factors of medical practice. While many dentists under the semblance of patients’ well-being do not unveil their mistakes, it is morally unethical. The doctor-patient’s fiduciary stripe is such that the dentist is forced to unveil medical errors to patients. The norm of respect for autonomy dictates that the medic should disclose mistakes to patients since it provides patients with an understanding of what is happening (Gross, 2019). Additionally, it diminishes the related anxiety and psychological pain that the patient may have. It also enhances consensus that makes a patient partisan to their medical care. The principle of nonmaleficence dictates that medics should not hurt patients. In essence, a medic who fails to reveal medical errors to the patients causes a dual-threat by providing unsatisfactory care and failing to explain to the victim, thereby violating their right to a fair reparation. The principle of beneficence directs medics to give their patients the priority while making decisions concerning them. In this case, the medics should disclose errors they make to their patients even in cases where it is likely to cost them their reputation or financial loss. Ethical courage is thus necessary if dentists and medics fraternity is to make the right choices when errors happen.
Literature review
According to a study conducted by Thusu et al. (2012) revealed that the most frequently reported issues in the dental practice were mistakes (36%), followed by patient injuries (10%), medical emergencies (6%), accidental ingestion or inhalation of clinical materials (4%), adverse reactions (4%), and erroneous tooth extractions (2%). Even though dentists have a moral duty to fully unveil errors, in practice, there is a substantial discrepancy concerning attitudes on the information that should be revealed, and who should do it (Blood, 2015).
To become a professional dentist, one has to adopt the following responsibilities; to acquire the skills of the dentistry to the standards set by profession, to stay updated on related developments in dentistry career, to place the patient’s interests above one’s interests, to abide by the dentists’ code of ethics, to serve the society without bias or prejudice, and to take part in self-assessment and regulation as a professional. By abiding by these statutes, the dentist should always be ready to pay for the cost of the damage they inflict on their clients regardless of how high it is.
Conducted in 2017 by the Saudi Dental Journal revealed the attitudes of dental professionals toward the unveiling of medical errors (Aboalshamat, 2017). The study involved a cross-sectional survey involved an administration of questionnaires to a sample of 586 participants admitted from over ten government and private dental organizations in Riyadh between August 2015 and January 2016 (Al-Nomay, 2016). According to the study, 94.4% of participants supported that medical mistakes should be revealed to patients. However, due to individual diversities of the norm and present practices relative to the magnitude of the error should be unveiled were not consistent. The study revealed that only 17.9% of the participants believed that it was the present practice to unveil mistakes that worsened the adverse effects (Aboalshamat, 2017). More than 68% of the participants proposed that the erring dentist should unveil the mistakes. Moreover, the study revealed that public practitioners are more likely to reveal errors than private dental practitioners.
In conclusion, the majority of the respondents felt that mistakes should be unveiled. However, there was little consensus between the respondents’ norms and views of the belief and practice relating to which type of errors should be revealed (Renton, 2016). Also, there was substantial unanimity that the dentist who makes a mistake should take the responsibility of communicating and handling the error. Notably, the respondent’s approach depended on the kind of organization, age, sex, and nationality.
Recommendations
According to the Canadian Dentist Association, a dentist should acknowledge the mistake once it occurs. Secondly, he/she should explain the facts related to the error that has happened, including what the patient should expect as a result of the problem and the procedure the dentist will take to mitigate the situation. Third, the dentist should express how remorseful they are and apologize for what they did to the patient. Next, they should take the laid-out procedures to reduce the harm caused to the patient. Lastly, the dentist should follow the risk management process of avoiding such a risk in the future.
In addition to the recommendations, the Canadian Dental Association also proposes that the dentist should try their best to regulate any further harm to the patient after making a mistake by halting the treatment immediately. However, the dentist should not leave the patient alone in the middle of the treatment procedure. He/ she should contemplate referring the patient to a dentist with a higher level of expertise since he /she may not have the capacity to rectify the mistake (Renton, 2016). They should prepare adequately for similar procedures in the future. More importantly, he/she should maintain communication with the victim. It is crucial for the dentist to comment on the factual truth about the incident, but should not go beyond that. Finally, the dentist should apologize and show sympathy to the victim where possible but centrally, seek advice before doing it. Moreover, it’s worth noting that the dentist should never cover up a mistake, but instead, should document it and state what emerged.
Conclusion
From the above arguments against and for nondisclosure, the differences in repercussions of nondisclosure are crystal clear. While a dentist may feel justified to hide the truth about an error that happened on a patient during care, it is unethical to violate the moral duty of integrity. Besides, repercussions of nondisclosure have proven to be worse than those of a disclosed mistake. Nevertheless, it is upon the discretion of the dentist to decide whether or not to disclose the mistake that happens as they care for the patient while being ready to bear the cost of the consequences.
References
Al-Nomay, N. (2016). Perception of dental professionals towards dental errors in Saudi Arabia. Journal of Public Health in Developing Countries, 2(2), 199-211.
Nainar, S. M. (2018). Adverse events during dental care for children: implications for practitioner health and wellness. Pediatric dentistry, 40(5), 323-326.
Aboalshamat, K., Alzahrani, M., Rabie, N., Alharbi, R., Joudah, R., Khulaysi, S., & Alansari,,, W. (2017). The relationship between burnout and perfectionism in medical and dental students in Saudi Arabia. Journal of Dental Specialities, 5(2), 122-7.
Holden, A. (2018). What do dental codes of ethics and conduct suggest about attitudes to raising concerns and self-regulation?. British dental journal, 224(4), 261-267.
Renton, T., & Master, S. (2016). The complexity of patient safety reporting systems in UK dentistry. British dental journal, 221(8), 517-524.
Zaghloul, A. A., Elsergany, M., & Mosallam, R. (2018). A measure of barriers toward medical disclosure among health professionals in the United Arab Emirates. Journal of patient safety, 14(1), 34-40.
Gross, D., Gross, K., & Wilhelmy, S. (2019). Digitalization in dentistry: ethical challenges and implications. Quintessence International, 50(10).
Murariu, A., Pricop, M., Bobu, L., Geletu, G., Danila, V., & Balan, A. (2016). e al., Ethics dimensions in dentistry. Romanian Journal of Oral Rehabilitation, 8(1).